Contraception and Family Planning — MCQs

Contraception and Family Planning Indian Medical PG Practice Questions and MCQs

Question 581: Which of the following is not related to the use of Levonorgestrel releasing intra-uterine contraceptive device ?

A. Reduction of pain and dysmenorrhoea in endometriosis and adenomyosis
B. Amenorrhoea in 50% of cases
C. Inhibition of ovulation (Correct Answer)
D. Reduction of blood loss

Explanation: ***Inhibition of ovulation*** - Levonorgestrel-releasing IUDs primarily act by thickening cervical mucus, thinning the **endometrium**, and creating a local inflammatory reaction that impairs sperm viability and fertilization. - While some systemic absorption of levonorgestrel occurs, it is generally **insufficient to consistently inhibit ovulation**, unlike higher-dose hormonal contraceptives. *Reduction of pain and dysmenorrhoea in endometriosis and adenomyosis* - The **local release of levonorgestrel** directly in the uterus helps to thin the endometrial lining, reducing prostaglandin production and mitigating pain associated with conditions like endometriosis and adenomyosis. - This local hormonal effect suppresses the growth of ectopic endometrial tissue and decreases uterine contractions, leading to a significant reduction in pain. *Amenorrhoea in 50% of cases* - The **endometrial thinning** caused by continuous levonorgestrel release often leads to a significant decrease in menstrual bleeding, and in about 50% of users, this results in complete amenorrhoea over time. - This effect is beneficial for women with heavy menstrual bleeding or dysmenorrhoea. *Reduction of blood loss* - Levonorgestrel-releasing IUDs are well-known for their efficacy in treating **heavy menstrual bleeding (menorrhagia)**. - The progestin causes significant atrophy and thinning of the endometrium, reducing the amount of tissue shed during menstruation and thus **decreasing blood loss**.

Question 582: Safe period is calculated by

A. Length of luteal phase
B. Length of menstrual cycle (Correct Answer)
C. Date of ovulation
D. Duration of menstrual flow

Explanation: ***Length of menstrual cycle*** - The **"safe period"** or **rhythm method** of contraception relies on estimating the fertile window by tracking the length of the menstrual cycle. - Ovulation typically occurs around day 14 of a 28-day cycle, and the fertile window includes the days leading up to and immediately after ovulation, which is determined by the overall cycle length. *Length of luteal phase* - The **luteal phase** is relatively constant in most women, lasting about **14 days**, irrespective of the overall cycle length. - While it's part of the menstrual cycle, its length alone does not provide enough information to calculate the fertile window for overall "safe period" estimation. *Date of ovulation* - The **date of ovulation** is a crucial component in determining the fertile window but is a specific point within the cycle, not the overall calculation method for the "safe period." - Methods to predict ovulation (e.g., basal body temperature, ovulation predictor kits) help identify the fertile window but are not how the cyclic "safe period" is initially calculated for planning purposes. *Duration of menstrual flow* - The **duration of menstrual flow** (usually 3-7 days) is highly variable among individuals and has no direct correlation with the timing of ovulation or the fertile window. - It marks the beginning of a new cycle but does not help in identifying the fertile days for natural family planning.

Question 583: In a woman using an intrauterine contraceptive device (IUCD) an unexpected pregnancy occurs and the IUCD threads are visible. What is the reason to recommend removal of the device ?

A. To prevent the risk of subsequent septic abortion and preterm labour (Correct Answer)
B. To prevent post partum haemorrhage
C. To prevent congenital abnormality of the newborn
D. To prevent perforation

Explanation: ***To prevent the risk of subsequent septic abortion and preterm labour*** - Retaining an IUCD during pregnancy significantly increases the risk of **septic abortion** and **preterm labor** due to the presence of a foreign body in the uterus. - Removing the IUCD when threads are visible can reduce these risks (reducing spontaneous abortion risk from ~50% to ~30%), although there's a small risk of miscarriage associated with the removal procedure itself. *To prevent post partum haemorrhage* - This is not a primary reason for IUCD removal during an ongoing pregnancy. **Postpartum hemorrhage** is typically related to uterine atony, placental abnormalities, or trauma during delivery. - While an IUCD might rarely interfere with uterine contraction, its removal during pregnancy is not specifically aimed at preventing postpartum hemorrhage. *To prevent congenital abnormality of the newborn* - An IUCD does not cause **congenital abnormalities** or **birth defects** in the fetus; its mechanism of action is primarily **preventing fertilization** through local spermicidal effects and interference with sperm-egg interaction. - Exposure to an IUCD does not have a teratogenic effect on fetal development. *To prevent perforation* - **Uterine perforation** is a rare complication that usually occurs during IUCD insertion, not during an ongoing pregnancy with an already in-situ device. - While an IUCD could potentially migrate or embed deeper, preventing perforation is not the primary or most urgent reason for its removal in the context of an unexpected pregnancy.

Question 584: Contraindications for medical abortions are all except :

A. Uncontrolled seizure disorder
B. Hemoglobin less than 8 gm%
C. Age more than 35 years (Correct Answer)
D. Undiagnosed adnexal mass

Explanation: ***Age more than 35 years*** - Age alone, including being over 35 years old, is **not a contraindication** for a medical abortion. - The decision for medical abortion is based on health status, gestational age, and patient choice, not primarily on age. *Uncontrolled seizure disorder* - An **uncontrolled seizure disorder** can be a relative contraindication due to the stress and potential risks associated with the abortion process, which could trigger seizures. - Prostaglandins used in medical abortion can sometimes **increase uterine contractions and pain**, which may exacerbate a seizure disorder. *Hemoglobin less than 8 gm%* - A **hemoglobin level less than 8 gm%** indicates significant anemia, which increases the risk of complications from blood loss during a medical abortion. - Patients with severe anemia may require **blood transfusion** if significant bleeding occurs, making medical abortion less safe. *Undiagnosed adnexal mass* - An **undiagnosed adnexal mass** can be a contraindication because it might mask an **ectopic pregnancy**, for which medical abortion drugs are not effective and could be dangerous. - It also raises concerns about potential **complications or rupture** of the mass during the abortion process.

Question 585: Oral contraceptives may provide protection against the following malignancies except :

A. Cervical cancer (Correct Answer)
B. Endometrial cancer
C. Ovarian cancer
D. None of the options

Explanation: ***Cervical cancer*** - Oral contraceptives (OCPs) are associated with an **increased risk of cervical cancer**, particularly with prolonged use, due to their potential influence on the immune response to **HPV infection**. - OCPs do not provide protection against cervical cancer; instead, they are considered a **risk factor** in its development. *Endometrial cancer* - OCPs, especially with their progestin component, offer significant **protection against endometrial cancer** by counteracting unopposed estrogen effects on the endometrium. - This protective effect is evident after just a few years of use and can persist for decades after discontinuation. *Ovarian cancer* - Oral contraceptive use is well-established to **reduce the risk of ovarian cancer**, with the protective effect increasing with longer duration of use. - This protection is thought to be mediated by the **suppression of ovulation**, thereby reducing the continuous trauma to the ovarian surface epithelium. *None of the options* - This option is incorrect because OCPs do provide protection against several malignancies, specifically endometrial and ovarian cancers, but actually increase the risk of cervical cancer.

Question 586: During the first 6 months of lactation, which amongst the following contraceptives is not advisable?

A. Norplant
B. DMPA
C. Progestin only pills
D. Combined oral contraceptive pills (Correct Answer)

Explanation: ***Combined oral contraceptive pills*** - **Combined oral contraceptive pills (COCs)** contain both **estrogen** and **progestin**, and the synthetic estrogen component can potentially reduce breast milk supply, which is critical during the initial 6 months of breastfeeding. - Estrogen may also alter the composition of breast milk, and there's a theoretical concern about **estrogen excretion into breast milk** affecting the newborn during this vulnerable period. *Norplant* - **Norplant** (levonorgestrel implants) contains only **progestin**, which is generally considered safe for use during breastfeeding from 6 weeks postpartum. - Progestin-only contraceptives do not significantly affect milk supply or infant health. *DMPA* - **DMPA (depot medroxyprogesterone acetate)** is an injectable contraceptive containing only **progestin**. It is considered safe and effective during breastfeeding, typically from 6 weeks postpartum. - It does not negatively impact milk production or infant growth and development. *Progestin only pills* - **Progestin-only pills (POPs)** are safe for use during breastfeeding, usually initiated immediately postpartum or from 6 weeks. - They do not contain estrogen, thereby avoiding the concerns associated with combined oral contraceptives regarding milk supply and infant exposure.

Question 587: All of the following are eligibility criteria for female sterilization except :

A. Client should be married
B. At least two living children should be present (Correct Answer)
C. Client's age should not be less than 22 years or more than 49 years
D. Client or her spouse must not have undergone sterilisation in the past

Explanation: ***At least two living children should be present*** - The number of **living children** is NOT a mandatory eligibility criterion for female sterilization in India. - The **Ministry of Health and Family Welfare** has explicitly removed parity requirements to expand access to sterilization services. - Current guidelines emphasize **informed consent** and **voluntary participation**, not the number of children. - This is the correct answer as it is clearly NOT an eligibility criterion. *Client should be married* - **Marital status** is also NOT a mandatory eligibility criterion in current Indian family planning guidelines. - However, this has been inconsistently applied, and the removal of the **two-child norm** is more explicitly documented. - Modern guidelines focus on individual autonomy and informed choice regardless of marital status. *Client's age should not be less than 22 years or more than 49 years* - **Minimum age of 22 years** is a valid eligibility criterion to ensure maturity and informed decision-making. - The upper age limit is generally aligned with reproductive age, though this varies. - Age restriction is a legitimate criterion under Indian guidelines. *Client or her spouse must not have undergone sterilisation in the past* - This is a logical eligibility consideration to prevent **duplicate sterilization** within a couple. - If one partner is already sterilized, the other typically does not need the procedure. - This ensures efficient use of resources and prevents unnecessary surgeries.

Question 588: A man underwent vasectomy, but 6 months later his wife was 16 week pregnant. What is the most likely cause ?

A. Recanalisation of vas
B. Failure to use additional contraception in postoperative period (Correct Answer)
C. Pregnancy antedating vasectomy
D. Failure of operative procedure

Explanation: ***Failure to use additional contraception in postoperative period*** - Sperm can remain viable in the distal reproductive tract for up to **3 months** after a vasectomy. - **Ongoing contraception** is essential until **sperm-free ejaculates** are confirmed by semen analysis. *Recanalisation of vas* - While possible, **spontaneous recanalisation** typically occurs much later, usually more than one year post-procedure, and is responsible for a smaller percentage of failures. - Recanalisation usually presents with **detectable sperm** in later semen analyses, which would have been identified if proper follow-up was conducted. *Pregnancy antedating vasectomy* - A 16-week pregnancy means conception occurred approximately **14 weeks prior** to the current presentation. - Assuming the vasectomy was performed **6 months ago**, conception would have occurred well after the procedure, making this option unlikely. *Failure of operative procedure* - A technical failure during the vasectomy would likely result in **immediate and persistent presence of sperm** in subsequent ejaculates. - This would typically be detected during the required follow-up semen analyses within the first few months, indicating the procedure was not effective from the outset.

Question 589: Following are the contraindications for laparoscopic female sterilization except :

A. Respiratory dysfunction
B. Hiatus hernia (Correct Answer)
C. Heart disease
D. Obesity

Explanation: ***Hiatus hernia*** - A **hiatus hernia** is **not a contraindication** for laparoscopic female sterilization. While it might increase the risk of reflux or aspiration during general anesthesia, this can be managed with appropriate precautions such as rapid sequence induction and cricoid pressure. - The surgical field and abdominal pressure changes associated with laparoscopy do not significantly impact hiatus hernia management. - **This is the correct answer** as hiatus hernia is not listed among contraindications. *Respiratory dysfunction* - **Severe respiratory dysfunction** is a **major contraindication** for laparoscopy due to the effects of **pneumoperitoneum** on respiratory mechanics. - **Increased intra-abdominal pressure** elevates the diaphragm, reducing lung capacity and increasing airway pressure, which can be detrimental in patients with compromised lung function. - Conditions like severe COPD, uncontrolled asthma, or restrictive lung disease significantly increase operative risk. *Heart disease* - **Severe heart disease**, such as **unstable angina, severe congestive heart failure, or recent myocardial infarction**, is a **major contraindication**. - The stress response to surgery, fluid shifts, and the cardiovascular effects of **pneumoperitoneum** (increased systemic vascular resistance, decreased venous return) can exacerbate cardiac conditions. - Patients with decompensated cardiac disease are at high risk of perioperative complications. *Obesity* - **Obesity** is considered a **relative contraindication** for laparoscopic sterilization, requiring careful patient assessment and surgical planning. - It increases operative challenges including difficult port insertion, reduced visualization, longer operative time, and higher risk of complications (wound infection, venous thromboembolism). - Unlike hiatus hernia, obesity requires special consideration and risk stratification before proceeding with laparoscopic sterilization.

Question 590: What is the recommendation for use of Levonorgestrel for the purpose of emergency contraception ?

A. Two tablets of 0-75 mg Levonorgestrel to be taken soon after the act of unprotected coitus but within 96 hours (Correct Answer)
B. One tablet of 0-75 mg Levonorgestrel to be taken soon after the act of unprotected coitus but within 72 hours
C. None of the options
D. One tablet of 0-75 mg Levonorgestrel to be taken soon after the act of unprotected coitus but within 120 hours

Explanation: ***Two tablets of 0.75 mg Levonorgestrel to be taken soon after the act of unprotected coitus but within 96 hours*** - This represents the **correct total dose of 1.5 mg** (0.75 mg × 2 tablets) for emergency contraception. - The standard regimen for **levonorgestrel emergency contraception** can be administered as either a **single dose of 1.5 mg** or as **two doses of 0.75 mg taken 12 hours apart**. - Current WHO guidelines recommend taking both tablets together (single 1.5 mg dose) for ease of compliance, which is equally effective as the split-dose regimen. - The **96-hour window** is within the acceptable timeframe, as levonorgestrel EC can be effective for up to **120 hours** (5 days) after unprotected intercourse, though efficacy is highest within **72 hours**. - The phrase "soon after" reasonably implies taking the tablets together or in quick succession, which aligns with current practice. *One tablet of 0.75 mg Levonorgestrel to be taken soon after the act of unprotected coitus but within 72 hours* - This option specifies only a **single 0.75 mg tablet**, which is **half the required total dose (1.5 mg)** for emergency contraception. - While the **72-hour window** is correct for optimal efficacy, the **insufficient dosage** makes this option incorrect. *One tablet of 0.75 mg Levonorgestrel to be taken soon after the act of unprotected coitus but within 120 hours* - This option also presents an **insufficient dose of only 0.75 mg** when the standard requirement is **1.5 mg total**. - Although **120 hours** represents the maximum effective window for levonorgestrel EC, the inadequate dosage makes this incorrect. *None of the options* - This is incorrect because **Option 3** appropriately describes the recommended total dose and timeframe for levonorgestrel emergency contraception based on current guidelines.

Practice by Chapter

Natural Family Planning Methods

Practice Questions

Barrier Methods

Practice Questions

Hormonal Contraceptives

Practice Questions

Intrauterine Devices

Practice Questions

Emergency Contraception

Practice Questions

Permanent Contraception Methods

Practice Questions

Contraception in Special Populations

Practice Questions

Contraceptive Counseling

Practice Questions

Side Effects and Complications of Contraceptives

Practice Questions

Future Contraceptive Technologies

Practice Questions

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